Provider Demographics
NPI:1710112958
Name:VANDERWAAL, JODY (MSW, QP)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:
Last Name:VANDERWAAL
Suffix:
Gender:F
Credentials:MSW, QP
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:VANDER WAAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, QP
Mailing Address - Street 1:101 GOVERNMENT AVE SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2936
Mailing Address - Country:US
Mailing Address - Phone:828-315-7000
Mailing Address - Fax:828-315-7701
Practice Address - Street 1:101 GOVERNMENT AVE SW
Practice Address - Street 2:SUITE 300
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2936
Practice Address - Country:US
Practice Address - Phone:828-315-7700
Practice Address - Fax:828-315-7701
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health